Children with attention-deficit/hyperactivity disorder (ADHD) appear likely to experience sleep problems, according to a report in the April issue of Archives of Pediatrics & Adolescent Medicine, a theme issue on children and sleep. Sleep problems in these children may be associated with poorer child psychosocial quality of life, child daily functioning, caregiver mental health and family functioning.
Attention-deficit/hyperactivity disorder is a behavioral disorder, usually first diagnosed in childhood, that is characterized by inattention, impulsivity and hyperactivity. "ADHD is the most common mental health disorder in childhood, affecting up to 11 percent of Australians aged 6 to 17 years," according to background information in the article. About half of parents of children with ADHD report that their children have difficulty sleeping, feel tired on waking or have nightmares or other sleep problems such as disordered breathing and restless leg syndrome. Parents of children with ADHD are more likely to experience stress, anxiety and depression than those of children without ADHD.
Valerie Sung, M.B.B.S., of the Centre for Community Child Health, Parkville, Australia, and colleagues studied families of 239 schoolchildren (average age 11.7) with ADHD to determine the prevalence and broad effects of sleep problems in these children. The association of sleep problems with child health-related quality of life, daily functioning, school attendance, primary caregiver mental health and work attendance and family impacts were also noted.
Sleep problems affected 175 (73.3 percent) of the children, with a 28.5 percent prevalence of mild sleep problems and 44.8 percent prevalence of moderate or severe sleep problems. Some of the most commonly occurring sleep patterns were difficulty falling asleep, resisting going to bed and tiredness on waking.
"Compared with children without sleep problems, those with sleep problems were more likely to miss or be late for school, and their caregivers were more likely to be late for work," the authors write. "Forty-five percent of caregivers reported that their pediatricians had asked about their children's sleep and, of these, 60 percent reported receiving treatment advice."
"In summary, sleep problems in schoolchildren with ADHD are extremely common and strongly associated with poorer quality of life, daily functioning and school attendance in the child and poorer caregiver mental health and work attendance," the authors conclude. "Implementation of a sleep intervention in children with ADHD could feasibly improve outcomes beyond treatment of ADHD alone. It is possible that such intervention could reduce the need for medication in some children."
"In the meantime, clinicians caring for children with ADHD should ask about their sleep, and if a problem is present, this should be addressed."
(Arch Pediatr Adolesc Med. 2008;162:336-342. Available pre-embargo to the media at www.jamamedia.org.)
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